Sunday, November 30, 2014

School kids around the country are tweeting pictures of their unappetizing school lunches and blaming the most prominent advocate for healthier school meals for their "bowls of mush and mystery proteins," Roberto A. Ferdman reports for The Washington Post.

The tweets use the hashtag #ThanksMichelleObama, which dates back to 2012. They were "being sent out at a rate of 40 per minute last week, but started to gain momentum some 10 days back," Ferdman writes.

The tweets and pictures vary, with some presenting a "mealy substance" or mystery food that is supposed to pass for the entree while others poke fun at how pitiful the presentation is.

"We've seen the photos being tweeted," said Sam Kass, executive director of Let's Move!, the organization Obama founded to fight childhood obesity. "But we don't dictate the food that schools serve—school districts do." He added, "We’ve seen thousands of examples of healthy, delicious school lunches that meet the new standards being made across the country by talented school chefs."

Obama has been a key player in the implementation of the new health standards in schools, which mandate an increase in fruits, vegetables and whole grains and place restrictions on calories,sodium, sugar and fat served in a school day. These restrictions were also added to snacks and beverages this year.

Several studies have reported great success with these new requirements. In Virginia, a recent study found that school lunches were "significantly healthier" than home packed lunches and a study in Massachusetts concluded the same thing.

But others say that this healthy food is not being eaten, but instead thrown away. A Harvard School of Public Health study in Massachusetts supports this conclusion, finding that "some 60 percent of vegetables and 40 percent of fresh fruit are thrown away (for good measure, even more vegetables—some 75 percent—were thrown out before the USDA school meal standards went into effect)," Ferdman reports.

Complaining about cafeteria food in certainly not a new phenomena, what is new is that "everyone has a camera on their phone and a public platform to share pictures," Ferdman writes.

Myths about the influenza vaccine circulate every year and make it difficult for some to decide whether to get the shot, Tom Watkins reports for CNN.

This prompted him to look at five of the most common myths and presents the "truth based on information from the Centers for Disease Control and Prevention."

Perhaps the most common myth is that the flu shot can give you the flu. The CDC says the virus in flu shots is dead and cannot cause infection. So why do some people feel bad after a flu shot? The CDC says that this is often caused by soreness at the injection site, which is caused by the immune system working to create antibodies to the killed viruses in the vaccine. Or, you could be sick with another seasonal illness that acts like the flu or have a flu virus that is not in the vaccine. Finally, especially among the elderly and people with weak immune systems, although the CDC says it still can prevent complications in this high-risk group. The CDC's Advisory Committee on Immunization Practices says "symptoms, in rare instances, include fever, muscle pain, and discomfort or weakness, which also typically go away after a day or two," Watkins reports.

Another myth is that it is better to get the vaccine late in the season so it will last longer. The CDC says that this is not true, Watkins reports: "The shot lasts an entire flu season, except for some children who may need two doses."

The third myth is that the flu shot might adversely affect pregnancy. The American College of Obstetricians and Gynecologists says "The flu vaccine is an essential element of prenatal care," and recommends a flu shot for all pregnant women, who are at higher risk for flu complications. Pregnant women should only get a flu shot, and not the nasal vaccine.

The fourth myth is the belief that "I've had the flu before and it was no big deal, so bring it on." This is a fallacy, Watkins reports, because seasonal flu "exacts a bigger toll in some years than in others because the viruses that circulate in one may differ than those that circulate in another" and people's response to viral infections differ from year to year.

The final myth is that the flu shot doesn't work. Watkins writes that while "it doesn't work all the time, it does offer some level of protection." According to the CDC, one study in 2010-2011 showed 60 percent efficacy for all age groups, and studies from earlier years found protection rates of up to 90 percent.

The CDC recommends that all people older than 6 months get a flu vaccine. They also recommend that you get it early because it takes two weeks from the time of the injection for the flu shot to work.

Saturday, November 29, 2014

Leftovers are a great way to stretch your food budget, but proper handling of them is important to make sure they maintain their taste and remain bacteria-free, says the Institute of Food Technologists.

In a news release, the institute suggests three keys for handling leftovers safely: proper refrigeration, containers and heating.

Leftovers need to be refrigerated within two hours of cooking (one hour on hot summer days or in warm climates). Modern refrigerators are built to cool hot dishes, and while it is both safe and energy efficient to cool food a bit before you refrigerate it, you don't have to completely cool it. Leftovers need to be just warm to touch, or around 90 to 100 degrees Fahrenheit before placing them in a refrigerator that is maintained at 40 degrees Fahrenheit or lower.

The best containers are thin-walled metal, glass or plastic and no more than 2 inches deep, but bags, foil and plastic wrap also work.

How long are leftovers safe in the refrigerator? It varies:

Cooked meat can be stored three to four days in the fridge, while uncooked ground meats, poultry and seafood will last only a day or two.

Raw roasts, steaks and chops (beef, veal, lamp or pork) can be refrigerated for three to five days.

Casseroles, veggies and similar side dishes, as well as pie, will usually last three to five days.

If you have more food than you can eat within these time frames, Shelke recommends freezing it. Uncooked meats can last eight to 12 months in the freezer, while frozen cooked meats will begin to lose their flavor after three months. Freezer temperature should be at zero F (-18 Celsius).

On the front end, how do you food has been heated to a safe temperature? The best way is to use a thermometer. Most foods, especially meats, should be heated to 165 degrees F in the center. The institute also recommends that you bring sauces, soups and gravies to a boil before serving.

It also recommends that you never reheat leftovers in crock pots, slow cookers or chafing dishes, and only reheat foods to a rare center if they were initially cooked properly.

Friday, November 28, 2014

Most people are not affected by occasional overindulging at holiday parties, but diabetics can get in serious health trouble if they aren't careful.

“If you are someone who is not in good control of your diabetes throughout the year, the holiday season can really make your situation worse,” Laila Tabatabai, an endocrinologist with Houston Methodist Hospital, says in a news release from the hospital. “If you are not mindful, eating foods with too many carbohydrates or sugars can send your blood sugar levels into a dangerously high range."

An abundance of high-fat, high-carbohydrate foods, parties with alcohol, desserts, food gifts and a change in routine that often doesn't allow time for exercise during the holiday season are some of the challenges that make it difficult for diabetics to maintain healthy blood sugar levels during the holidays.

The American Association of Diabetes Educatorssays in a news release that the best way to meet these challenges is to plan ahead.

“With the holidays coming, take some time to think about how you’ll deal with the events, the family you’ll be visiting and all of the to-dos,” Joan Bardsley, president of the group, said in its release. “By planning ahead you can enjoy the fun and still be healthy.”

The diabetes educators offer some tips on how to plan for these challenges:

Make a healthy eating contract before attending a big meal, write down some goals and stick to them.

Plan your plate: fill half of your plate with veggies, one-quarter with carbs (whole grain if possible), and one quarter with lean meat

Avoid dark meat and remove any skin from your meat before eating

Avoid gravy, and if you must have it, use only a little.

Check with your doctor to make sure it is safe for you to have alcohol as it can interfere with some medications, including insulin. Sparkling water with a lime twist is a nice alternative.

If alcohol is allowed, limit your intake. Have one glass of wine per party and skip the mixed drinks, which have more carbs. Or have a spritzer, half sparkling water and half wine. If drinking alcohol, make sure you eat, to avoid low blood sugar.

Stay active during the holidays. Involve the family in activities that gets everyone up and moving, volunteer or sign up for a holiday run or walk.

Minimize stress. Make time to unwind and relax.

See a diabetes educator; they can help you make a plan for the holidays.

Tabatabai also suggested to be selective in the foods you choose to eat, only eating the special holiday dishes instead of everything; to bring a healthy dish that you enjoy; to avoid "white" carbohydrates such as potatoes; to limit portion sizes and to make sure family and friends are aware of your diabetes so that they can accommodate your food choices.

“Planning ahead and being smart with your choices will give you the chance to eat the foods you want while maintaining healthy glucose levels,” Tabatabai said in the release.

The AADE also offers these tips on traveling with diabetes:

Bring extra medication and supplies if you are traveling.

Pack two weeks worth of medication and supplies for one week of travel in case of travel delays or lost supplies. Make sure you include insulin, syringes, testing strips, insulin pump supplies, a first-aid kit, glucagon emergency kit, etc.

Bring a prescription from your doctor for insulin or oral medication in case of emergency.

If you are traveling by air, keep your medications and supplies with you at all times.

A jury has decided for the St. Joseph London hospital, several of its doctors and other defendants in a lawsuit that accused them of conspiring "to perform unnecessary, risky and often painful heart procedures to unjustly enrich themselves," Andrew Wolfson writes for The Courier-Journal.

After a three-week trial of the suit filed by Ed Marshall, the Laurel Circuit Court jury took only 40 minutes Nov. 21 to decide there had been no wrongdoing, Nita Johnson reports for The Sentinel-Echo. However, The C-J reports that the case was only the first of 12 "that will be tried to show the value of the cases to both sides,
according to Louisville lawyer Hans Poppe, one of the plaintiff's
lawyers. . . . He said Marshall had suffered five heart attacks before he was allegedly
given an unnecessary stent and that the jury may have been reluctant to
fault the defendants given his complex prior medical history."

"Marshall’s lawsuit
spurred five other cardiology patients to step up with claims that the
doctors were doing unnecessary procedures on patients with heart
problems," Johnson reports. "The list of lawsuits continued to expand, with numerous
patients and the family members of deceased patients joining in with the
claims that the cardiologists were performing procedures that were not
medically necessary. Before all was said and done, over 200 people had
filed lawsuits against the London hospital, its owning agency – Catholic
Health Initiatives; the cardiovascular company that referred patients
to the local hospital, the medical billing organization, and individual
cardiologists involved in certain procedures. One of those cardiologists – Sandesh Patil – is serving federal prison time for falsely billing
Medicare for procedures" that the Kentucky Board of Medical Licensure said didn't meet minimum guidelines.

In January, the hospital agreed to pay the federal government $16.5 million to resolve "civil allegations that it submitted
fraudulent claims to the Medicare and Kentucky's Medicaid programs for
unnecessary heart procedures," Wolfson notes. The deal also put the hospital under a corporate integrity agreement, and its president and chief nursing officer were replaced in September by officials who have experience in operating under such agreements, R. Scott Belzer reported for The Sentinel-Echo.

Tuesday, November 25, 2014

In an effort to combat the country's obesity epidemic, the Food and Drug Administration issued final regulations Tuesday that will require chains with 20 or more restaurants, movie theaters and pizza parlors to post calorie counts on menus.

"The rules will have broad implications for public health," Sabrina Tavernise and Stephanie Strom report for The New York Times. "As much as a third of the calories that Americans consume come from outside the home, and many health experts believe that increasingly large portion sizes and unhealthy ingredients have been significant contributors to obesity in the United States."

“This is one of the most important public health nutrition policies ever to be passed nationally,” Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest, told the authors. “Right now, you are totally guessing at what you are getting. This rule will change that.”

The numbers "could be a pretty big wake-up call," writes Jason Millman of The Washington Post. "The FDA rules are more comprehensive than expected, given the strong industry pushback since the menu labeling provision was included in the 2010 health-care law." The FDA proposed a rule in 2011, but heavy lobbying has delayed its finalization.

"Do people eat healthier when they can see calorie counts?" Milliman asks. "The evidence so far seems mixed. The impact seems to be greater when the calorie count is much higher than what consumers expect. What does seem clear from past studies is that people really are terrible judges of how many calories they consume when they dine out [and] are especially bad judges of the calorie content of the least healthy foods commonly found of restaurant menus."

The rules also cover food in vending machines, amusement parks, alcohol if it is on the menu or a menu board, and some prepared foods in supermarkets. Chain restaurants are defined as food establishments with 20 or more outlets.

The policy will take effect a year from now, "and seems likely to face legal and political challenges from some parts of the food industry, including grocery and convenience stores that sell prepared foods for takeout," the Times reports.

The National Grocers Association told the paper, “Grocery stores are not chain restaurants, which is why Congress did not initially include them in the law. We are disappointed that the FDA's final rules will capture grocery stores, and impose such a large and costly regulatory burden on our members.”

Daren Bakst, a research fellow in agricultural policy at the conservative Heritage Foundation, told the authors that the FDA interpreted the law too broadly. “If Congress wanted to cover any establishment that sells prepared foods, they would have said that,” he said. “No reasonable person is about to confuse a grocery store, convenience store or movie theater with a restaurant.” But retiring Democratic Sen. Tom Harkin of Iowa, who helped create the labeling requirement, said the rule “closely mirrors congressional intent.”

The FDA offered some concessions to grocers, convenience stores, pizza chains and vending-machine owners. For example, pizzerias can define their serving sizes and list calories by the slice, and vending machine owners have been given an extra year to comply.

Sunday, November 23, 2014

The 80,000-plus Kentuckians who bought private health insurance during the first open enrollment period under the federal health-reform law are getting letters notifying them of their new premium and subsidy amounts. Most policies will cost more, and the overall average increase is expected to be 4.6 percent.

Policyholders will be automatically enrolled in the same plans as last year, but should check the state's Kynectwebsite to see if a better plan is avaialble. The second enrollment under the law is open through Feb. 15.

Kentuckians are showing "brisk interest" in Kynect coverage, according to a news release from Gov. Steve Beshear's office. It said that as of 11 a.m. Friday:
• 72,335 unique visitors to the site had viewed 2.1 million web pages;
• 45,412 people had conducted preliminary screenings;
• 4,180 new accounts had been created;
• 6,471 new applications had been submitted;
• 8,727 people had made changes to existing applications; and
• 3,199 people renewed their enrollment in a private health-insurance plan.
• 908 people newly enrolled in a private plan.

The release said more than 1,800 people had visited the new, federally funded Kynect store at Fayette Mall in Lexington, and 522 of them had completed applications for new coverage.

“We made tremendous headway last year, but we still have thousands of Kentuckians who need insurance for themselves and for their families,” said Carrie Banahan, executive director of Kynect. “Not only do we encourage first-time insurance buyers to check out Kynect online, by phone or in person with an insurance agent or Kynector, we are also strongly encouraging those who enrolled last year to check out the plans available for 2015. You could get a bigger subsidy, a lower monthly cost, or more network options if you shop again.”

Health education, communicating with physicians, and patient- and family-centered care that empowers patients to be their own best health advocates, were some of the topics discussed at the Health Watch USA conference in Lexington this month.

Joycelyn Elders

“Patient empowerment is the right of the patient to take an active role in decisions about his or her own care,” said former U.S. surgeon general Joycelyn Elders, professor emeritus of pediatric endocrinology at the University of Arkansas. “But you can't make a good decision if you have not been educated. You can't keep an ignorant population healthy.”

Waiting until a person is old and set in their ways and then trying to teach them better health strategies doesn't work, Elders said. For patients to really be involved in their health, health education must start early.

“We must push for comprehensive health education in our school systems from kindergarten through 12th grade,” she said. “It is just as important as teaching reading, writing, and arithmetic. . . . We need to have science-based answers rather than ubiquitous myths. We need to protect people by arming them with correct information.”

Elders offered some practical suggestions to help patients become more empowered during their doctor's visits:

Take a trusted person with you.

Ask questions if you don't understand.

Bring all of your medications with you.

Write down questions and concerns before you go.

Ask your doctor to write down information and instructions discussed.

Make sure to tell your doctor if you have vision or hearing problems.

Elders said health education for physicians could also be improved, by putting more emphasis on preventive care and the treatment of chronic diseases, which are 75 percent of diseases in the United States, rather than acute diseases.

“We spend only 3 percent of our health-care dollars on keeping people well,” Elders said. “We have to do a better job. We haven’t educated our doctors.”

Karen D. Meyers

Karen D. Meyers, a lawyer who works with catastrophic-injury victims and health-care providers, said medical schools must start teaching doctors how to become better collaborators, not only between specialties, but with their patients as we move toward a model of patient and family centered care.

“They must learn to treat patients with dignity and respect, listen and share information with their patients, and allow patients to participate in their care,” said Meyers, who became an advocate for patient- and family-centered care after becoming a health advocate for her mother, who was in a coma for 40 days.

Elders said patient empowerment requires the patient to take some responsibility for his or her care, which requires respectful communication and shared decision-making between the doctor and the patient. The current physician-patient model of care does not support this concept, Elders said: “This has to change.”

Meyers concurred, saying physicians, hospitals and patients must change the attitude of “my patient, my treatment plan, my procedure, my case” to a model that recognizes that “everything about a patient's health belongs to the patient and their family.” She added, “Patients have to understand, because they are responsible for their care.”

Health Watch USA, based in Somerset, was founded by Dr. Kevin Kavanagh to promote health care transparency and patient advocacy, according to its website. For its report on the conference, in PDF format, click here.

A shift to cheaper, readily available heroin is partly to blame, Audrey Haynes, secretary of the Cabinet for Health and Family Services, told the legislature's Interim Joint Committee on Health and Welfare Wednesday.

Haynes told the committee that heroin overdose deaths in Kentucky increased 207 percent from 42 in 2011 to 129 in 2012; Kentucky ranks highest in hospital admissions for heroin abuse among surrounding states and the national average; more women age 18-44 in Kentucky die from drug overdoses than the U.S. average; and the state has shown a 165 percent increase in neonatal abstinence syndrome in newborns from 2008 to 2013.

Another issue, Wheatley writes, is that opiate treatment drugs like buprenorphine, which can be prescribed by physicians, have been seized by police in arrests at higher rates, creating a concern among health officials that it is being used illegally.

The medical director of the Department for Medicaid Services, John Langefeld, told Wheately that data show a 241 percent increase in buprenorphine prescriptions for Medicaid recipients from January 2012 to this May and that police seizures of this drug have increased "threefold" since tougher laws on prescription drug abuse took effect in July 2012.

A study has found that electronic cigarettes help people cut back on their use of tobacco, Christopher Ingraham reports for The Washington Post.

The finding was part of a study published in the International Journal of Environmental Research and Public Health, which tracked 48 smokers who were unwilling to quit smoking.

Participants were divided into three groups: two e-cigarette groups and a control group that switched from tobacco to e-cigarettes two months into the eight-month study. During the testing period all three groups were only allowed e-cigarettes. The difference between the groups occurred in between the testing periods.

"At the end of the 8-month study, 21 percent of all participants had stopped smoking tobacco entirely," Ingraham writes. "An additional 23 percent reported cutting the number of tobacco cigarettes they smoked per day by half." Across all three groups, total tobacco consumption fell by 60 percent, and 44 percent of the smokers had reduced or eliminated their tobacco use at the end of the eight months, Ingraham reports.

"The nicotine e-cig offers many smokers a successful alternative for smoking less – or even quitting altogether," write authors Frank Baeyens and Dinska Van Gucht. "E-cig users get the experience of smoking a cigarette and inhale nicotine vapor, but do not suffer the damaging effects of a tobacco cigarette.”

Ingraham lists many of the pros and cons of e-cigs and concludes, "From a public health standpoint, if we're interested in promoting smoking cessation it would seem sensible to encourage studies like this one, which point to new avenues for reducing the harms of smoking and helping people quit altogether."

The schools in another longtime tobacco county in Southern Kentucky are going tobacco-free. With only one member in opposition, the Casey County Board of Education recently enacted a tobacco-free school policy beginning with the 2015-16 academic year, Abigail Whitehouse reports for The Casey County News.

Jelaine Harlow, health educator for the Lake Cumberland District Health Department, presented the board with letters from community partners supporting a tobacco-free school policy, and results from surveys that showed 70 percent of school parents in the county school support a tobacco-free school policy, Whitehouse reports.

The surveys included ones given to parents and students across the school district including a ninth-grade student survey, a teacher-opinion survey, and a parent survey. It also included opinion results from attendees at a Casey County basketball game that showed overwhelming support for tobacco-free policy.

Following Harlow’s presentation, Beverly Hoskins, who taught at Casey County High School for 30 years, voiced her support for a tobacco-free campus. She said her father's tobacco crop put her through college, but "has lost the two men she loved the most to smoking, first her father and then her husband," Whitehouse writes.

Board Chairman Ken Coffman first said the issue would be decided later, but member Marilyn Coffey said, “Ken, I believe some of us are ready to vote. I think we’ve had a year to think about this and I’d like to make a motion to pass it and phase it in.” the motion carried, with only Vice Chairman John Cox opposed.

The school board in Clinton County also heard a similar plea from the same health department, including a report that high-school sophomores' use of smokeless tobacco had increased, but took no action, the Clinton County Newsreports. The high-school principal noted that many school employees smoke.

The health department noted that school boards in Somerset, Adair County and Russell County had recently enacted tobacco-free policies. Since the end of the federal tobacco program in 2004, tobacco production in the area has sharply and steadily declined, leaving tobacco with little of the political support that once insulated it from government controls.

With school-board elections held this month, and not to be held for another two years, there may be more such votes in the near future.

Kentucky School Boards Association spokesman Brad Hughes said in an e-mail that as of June, 33 of the state's 173 school districts had adopted all-encompassing tobacco-free campus policies; 12 have adopted policies that only affect students and staff, with no restrictions for visitors and groups renting district facilities. Four have adopted tobacco-free policy language with exceptions, such as allowing smoking in personal vehicles or at outdoor events; and four have asked KSBA to draft tobacco-free policy language, but have not yet reported final adoption of those policies. Hughes noted that smoking by underage students is prohibited by law anywhere, including in schools, in buses and anywhere on campus.

Thursday, November 20, 2014

Cigarettes and all other tobacco products, as well as e-cigarettes, are no longer allowed on most state property, both indoors and outside, and some state workers aren't happy about it, Jack Brammer reports for the Lexington Herald-Leader.

"Under the new rules, employees and visitors to executive branch agencies of state government won't be able to light up or chew tobacco in state-owned or state-leased buildings, in state-owned vehicles or on state property — including parking lots, sidewalks and green space under the control of the executive branch of government," Brammer writes, reporting that state workers "are fuming about it."

Human Resources Building, from main highway entrance

About a dozen people smoking outside the state Human Resources Building last week told Brammer they were not happy with the policy. All but one did not want to be identified for "fear of retribution," he reports, but Andrea Schank of Frankfort told him, "It feels like discrimination against smokers." She and the others said there should be a designated smoking area. State Personnel Secretary Tim Longmeyer told Brammer that wouldn't happen. He said state officials understand how addictive smoking is and they "are helping people to stop."

David Smith, president of the Kentucky Association of State Employees, said "state workers who smoke should have a designated area and called the state's ban on smoking in personal cars on state property 'really invasive,'" Brammer writes.

Schank told Brammer that workers in the building will now have to walk about a half-mile to smoke, but that may not be the case if a new enterprise stays in business. Bill Bryant of WKYT-TV reported on KET's "Comment on Kentucky" Friday night that a van is circulating in and around the huge Human Resources campus, giving smokers a ride to places off the campus during work breaks.

State government is the largest employer in Kentucky, and the tobacco-free rule will affect about 33,000 state workers, plus hundreds of thousands of visitors to state offices and properties. Gov. Steve Beshear makes no apologies for the executive order that put this policy in place, justifying his decision with Kentucky's dismal health statistics. Kentucky ranks first in smoking and cancer deaths.

Kentucky is the fifth state to adopt such a policy. The others are Delaware, Oklahoma, Oregon and South Dakota. Details of the policy can be found at https://tobacco-free.ky.gov.

Drugs that have been used for the last 30 years to treat HIV and AIDS could also be used to treat age-related macular degeneration in the eye and other inflammatory disorders, says a University of Kentucky news release.

The "landmark study" was led by Dr. Jayakrishna Ambati, professor and vice chair of UK's Department of Ophthalmology and Visual Sciences and has been published in the journal Science.

Age-related macular degeneration is a progressive condition that is untreatable in up to 90 percent of patients and is a leading cause of blindness in the elderly worldwide. There are two forms of AMD, wet and dry. Wet AMD has several therapies available, which are not always successful. Dry AMD has no approved treatments.

The most widely used class of anti-HIV drugs are thought to work as a treatment for HIV/AIDS patients because of how they target a specific enzyme that is critical for the replication of HIV. The drugs are nucleoside reverse transcriptase inhibitors.

The study found "NRTIs prevented retinal degeneration in a mouse model of dry AMD," the release reports. The toxic molecule that causes dry AMD requires the same enzyme to fulfill its life cycle as the enzyme that is responsible for replicating HIV; NTRIs target that enzyme. Surprisingly, the study found that NRTIs target it indirectly, by blocking an immune pathway, says the release.

"Repurposing of NRTIs could be advantageous, for one, because they are very inexpensive," Benjamin Fowler, the lead author and a postdoctoral fellow in the Ambati lab, said in the release. "Moreover, through decades of clinical experience, we know that some of the drugs we tested are incredibly safe. Since these NRTIs are already FDA-approved, they could be rapidly and inexpensively translated into therapies for a variety of untreatable or poorly treatable conditions."

The Kentucky Rural Health Association is asking Kentuckians to contact their legislators and advocate passage of a statewide smoking ban in the 2015 session of the General Assembly.

KRHA Executive Director Tina McCormick writes, "Smoke-free laws have been unmitigated and popular successes here in Kentucky at the local level and virtually everywhere they have been implemented. Comprehensive laws protect everyone equally, achieve nearly universal compliance, and improve air quality and the health of workers almost immediately." To read McCormick's article, click here.

"Despite a smoking ban and a tobacco-free campus policy starting Thursday for any of the more than 3,000 state buildings, legislative employees working at the Capitol Annex can still light up without a write-up," Brad Bowman reports for The State Journal in Frankfort.

Gov. Steve Beshear's new policy bans use of tobacco products in all executive branch properties, with a few specific exceptions. The ban took effect Thursday, to coincide with the American Cancer Society’s "Great American Smokeout Day," which encourages smokers to quit.

Beshear can set policy for all such properties except those in the Capitol and Capitol Annex, which are set by law. “The statute prohibits smoking in public areas, such as hallways, offices shared by more than one person, stairwells, restrooms, the cafeteria and conference rooms,” Robert Weber, public information officer for Legislative Research Commission, told Bowman. The state House “prohibits smoking in common areas and office suites,” House Speaker Greg Stumbo said.

The state Supreme Court recently voted to make its Capitol space smoke-free, and “The use of tobacco products is prohibited in all areas of the AOC campus without exception,” Administrative Office of the Courts spokeswoman Jamie Neal told Bowman. “This includes common work areas, conference and meeting rooms, private offices, hallways, break rooms, restrooms, outdoor grassy areas, picnic-table areas and parking lots.”

Beshear's office says about 5,000 executive branch state workers report using tobacco, "raising their health care costs an average of 20 percent higher than those that don’t," Bowman reports.

Exceptions to Beshear's order include state parks, the state fairgrounds, the Frankfort convention center, state-maintained rest areas, military training centers and armories.

Carrie Banahan, executive director of the Kentucky Health Benefit Exchange, has been selected by Governing magazine as one of nine 2014 Public Officials of the Year.

The magazine, for state and local government officials, has presented the awards since 1994 to recognize excellence in state and local government.

The magazine said it chose Banahan "for her tireless work overseeing the creation, development and promotion of Kynect," the brand for the insurance exchange created under the federal health-reform law. Her profile will be featured in the December issue of the publication.

“Lots of things had to go right before Kentucky became the nation’s gold standard for health-care implementation, and the first thing we did right was to name Carrie Banahan as kynect’s executive director,” Gov. Steve Beshear said in a release from his office. “Carrie not only had the perfect mix of experience and technical know-how to direct Kynect, she had the passion for the job."

Over her more than three decades of public service, Banahan has served as deputy commissioner of the Department of Insurance, deputy commissioner of the Department for Medicaid Services and executive director of the Office of Health Policy in the Cabinet for Health and Family Services.

“Carrie was truly the perfect person for this job. It is as if her whole career has been training her for this very opportunity,” Cabinet Secretary Audrey Haynes said in the release. "She is certainly deserving of this prestigious honor.”

Kynect has enrolled more than 521,000 Kentuckians in health care coverage, with three out of every four enrollees reporting they did not have health insurance prior to signing up, says the release. The Gallup Organization found that the percentage of Kentuckians without health insurance fell from 20.4 percent in 2013 to 11.9 percent midway through 2014, second only to Arkansas, the other Southern state that expanded Medicaid.

Wednesday, November 19, 2014

Kentucky officials say the state’s Medicaid expansion under the federal health-reform law has enrolled more residents and created more jobs than expected, but a study will see whether the expansion will pay for itself, as an earlier study and Gov. Steve Beshear predicted.

Eric Friedlander, deputy secretary of the Cabinet for Health and Family Services, reported both a larger-than-expected Medicaid enrollment in every county and an increase of 17,000 jobs in Kentucky from Medicaid expansion at Monday's meeting of the legislature's Interim Joint Committee on Appropriations and Revenue.

Friedlander also discussed other benefits of Medicaid expansion, saying Kentucky health-care providers had received $892,973,500 in reimbursements from January to October of 2014, reports Brad Bowman of The State Journal in Frankfort.

Cabinet Secretary Audrey Haynes told Kentucky Health News on Tuesday that on the previous Friday, the cabinet had passed $1 billion in payments of federal money to health-care providers for treatment of people newly eligible for Medicaid: those with household incomes between 69 percent and 138 percent of the federal poverty level. About half the money has gone to hospitals, she said.

Also, some legislators have expressed concern about the cost of expanding Medicaid rolls, which grew more than predicted by a study that Beshear cited in his expansion decision. As the law outlines, the federal government will pay 100 percent of the costs until Jan. 1, 2017, when the state will begin paying a small share rising to the law's limit of 10 percent in 2020.

Republican Sen. Chris McDaniel of Taylor Mill, who is running for lieutenant governor on the gubernatorial slate headed by Agriculture Commissioner James Comer, asked Friedlander what Kentucky’s financial obligations would be because of the expansion in the next few years. He said that is uncertain.

Under initial estimates, based on the study by PriceWaterhouse Coopers, expansion was expected to cost the state only about $150 million a year when it was paying 10 percent of the cost. But the study only forecast that fewer than 300,000 newly eligible Kentuckians would sign up for Medicaid in the first year, but about 337,419 did.

To get updated cost projections, Beshear has contracted for a second analysis by an independent agency, which Friedlander said should be completed by mid-January, reports Ronnie Ellis of CNHI News Service.

The governor said the new study will speak for itself, reports Tom Loftus of The Courier-Journal. "I was confident after that initial report that we could certainly afford down the road over the next eight years to expand Medicaid and stay within our budget. I'm still confident," Beshear said.

The Kentucky Rural Health Association will participate in National Rural Health Day, held on the third Thursday in each November, to spread awareness of rural health-related issues and promote the efforts of all rural stakeholders, says a press release from KRHA.

The association says it advocates for the interests of rural health by bringing together multiple parties to work together rather than in silos, working in collaboration to address the needs of rural Kentuckians. This year it has worked on issues such as immunizations, rural hospital impact, health professions recruitment, and tobacco use.

The KRHA joins the National Organization of State Offices of Rural Health Thursday, Nov. 20, to celebrate National Rural Health Day with plans to draw attention to several key issues related to Kentucky's rural health including health professions training, loan repayment, substance abuse treatment, mental health and Area Health Education Centers.

Approximately 62 million people, nearly one in five Americans, live in rural and frontier communities, and in Kentucky, 1.8 million citizens, or two of five, live in rural areas, the release notes. More information about National Rural Health Day can be found by clicking here.

Ernie Scott, director of the Kentucky Office of Rural Health, has received the 2014 Emerging Leader Award from the National Organization of State Offices of Rural Health.

Scott received his award Oct. 28 during the organization’s annual conference in Omaha. It is given annually to a state staff member who has demonstrated new leadership, initiative, involvement and commitment to the rural-health mission, a University of Kentucky news release reports.

Scott has been director of the state office since 2013. He is editor of a statewide rural health magazine, slated to begin quarterly publication in January. He has held leadership roles in state and national organizations.

Fran Feltner, director of the UK Center of Excellence in Rural Health, said in the release.“We are honored to extend our sincere congratulations to Ernie for this well-deserved recognition. The emerging leaders award appropriately reflects his passion for rural health, as well as the depth of knowledge and commitment he has for important health care issues in rural communities.”

Tuesday, November 18, 2014

As the Patient Protection and Affordable Care Act's second enrollment period gets underway, supporters of the law say it boosts the economy by creating an affordable, accessible insurance market that's not dependent on employer-based insurance.

Travis Kalanick, co-founder of Uber, said the law has been "huge" for his personal-transportation business. Uber's drivers are independent contractors, so the company does not provide them with health insurance. But because the ACA creates a functioning individual market for health insurance, making it easier and more affordable for Uber drivers and others to buy coverage on their own, Americans don't have to stay in a job just to keep their health insurance.

"The democratization of those types of benefits allow people to have more flexible ways to make a living,” Kalanick said during dinner for reporters, according to Buzzfeed. “They don’t have to be working for The Man.”

This is why Uber loves Obamacare, reports Jason Millman of The Washington Post. For a company like Uber, it's about liberalizing the workforce so that people are able to take jobs they do like that don't provide health care, he writes.

Numerous sources cite the ability of individuals to obtain affordable coverage outside of the workplace as a boon to the labor market. A Congressional Budget Office analysis earlier this year said giving families more options for obtaining affordable health insurance outside the workplace, the PPACA removes a barrier to job mobility and boosts the economy.

Before the PPACA, many Americans’ only source of secure health-insurance coverage was through their jobs because without work-based plans, people often found coverage to be too expensive or impossible to obtain due to pre-existing conditions. This created a health-insurance obstacle to labor mobility, which is sometimes called "job lock", writes the Jason Furman in an online post from the White House Council of Economic Advisers.

Job lock can prevent individuals who want to look for a better job, change careers or start a new business from doing so for fear of not having health coverage, the CBO said. Now, because of both the PPACA’s patient protection measures and ban on discrimination against people with pre-existing conditions, Americans have reliable access to health insurance without having to count on employers to provide it, says the report. CBO also said many Americans will be able to start small businesses or take new positions where they can be more productive because they don't have to worry about health insurance.

Opponents of the law argue that it shrinks the labor market. For example, in a Forbes article, Avik Roy writes that the law hampers job growth by imposing one of the largest tax hikes in U.S. history, increasing the cost of employing workers and establishing exchange subsidies that encourage workers to drop out of the job market. They cite a CBO estimated that by 2024, 2.5 million full-time-equivalent workers will drop out of the job market. Jay Carney, then White House press secretary, celebrated the findings, arguing that they mean that Americans would no longer be “trapped in a job,” Roy writes.

Sunday, November 16, 2014

Kentucky hospitals are so plagued by bad debts that they are asking some patients to pay in advance, Grace Schneider reports for The Courier-Journal.

"We always encourage them to try to pay something in advance" if they have an insurance policy with a large dedictible, said Donna Ghobadi, assistant vice president of managed care and revenue cycle for Baptist Health, which includes seven hospitals. Still, "We won't turn anybody away."

Schneider notes that Americans "have been shifted to high-deductible health care plans that require the employee to spend thousands of dollars on doctors and prescriptions before insurance kicks in. Estimates are that such plans covered one in nearly five Americans this year, a sharp increase from one in 25 in 2006, according to the Kaiser Family Foundation's 2014 Employer Health Benefits Survey."

Also, "Health-care reform also is shifting the burden for patients to come up with cash for their care in many instances," Schneider reports. "Of the 7.3 million people enrolled in federal and state exchanges under the Affordable Care Act this year, roughly a fifth nationwide and in Kentucky selected bronze-tier plans, which carry deductibles exceeding $5,500 per person. Bronze plans lack subsidies that silver and other plans provide to help pay out-of-pocket costs for those who meet income-eligibility thresholds." But many patients don't seem to realize that, hospitals say.

"Meanwhile, there has been an increase in employers offering an additional benefit at annual health-care enrollment of an insurance policy paid by the employee to cover a critical illness and care after an accident, said Jeff Bringardner, vice president of Regional Market Development for Humana," Schneider reports.

Saturday, November 15, 2014

The Patient Protection and Affordable Care Act's second annual open enrollment period has started and brings with it many changes.

Kentuckians can useKynect, the state’s health insurance exchange, to purchase their plans. They can also use Kynect to sign up for Medicaid, if they qualify. During the first open enrollment period under the 2010 federal law, more than 521,000 people obtained coverage through Kynect.

About 85,000 of them purchased private insurance plans, and most of those received a federal subsidy. The rest were added to Medicaid, the government health insurance program for the poor and disabled.

People who have been added to Medicaid do not need to sign up again, but should report income changes to the managed-care organization that handles their coverage. They can change their MCO until Dec. 12.

Even those who purchased plans through Kynect last year should re-enroll and consider purchasing a different plan this year because plans have changed, new plans are being offered and there have been changes in the factors used to calculate premiums and subsidies. The penalty for individuals without health coverage in 2015 will be $325 per adult or 2 percent of household income, whichever is greater. That's going to be more of sting than this year's $95-or-1 percent penalty.

Health plans will send a new tax document, IRS Form 1095-B, to policyholders to document 2014 coverage. While some exemptions are available for a short lapse of coverage up to 3 months, most taxpayers without coverage must pay the 2014 penalty and will get a taste of the higher penalties to come.

Plans on Kynect still vary widely. In addition to comparing premiums, it is important to consider deductibles, co-payments and other plan details. Kynect offers four basic types, labeled bronze, silver, gold and platinum. Bronze plans have the lowest premiums but have the highest deductible. As you move up the plan spectrum to platinum, your premiums increase and your deductibles decrease. The exchange also offers people under 30 a plan that provides only catastrophic coverage with a very high deductible and no subsidy.

Expect premium and plan changes

Premium increases in 2015 are likely for most Kentuckians, but some premiums could decline slightly. Rate filings indicate plans with Kentucky Health Cooperative could increase an average of 20 percent, while plans with Humana could increase an average of 12.8 percent. The tax-credit subsidy available to people with incomes between 100 and 400 percent of the federal poverty level ($11,670 to $46,680 for an individual) reduced the effect of premium increases.

Buyers should be watch for changes in plans because subsidies are based on the second-lowest-cost plan, silver, and many of these plans have changed in 2015. When that happens, people may face substantial premium increases unless they take the time to shop and make sure they’re still in a low-cost plan.

Fortunately, this year the actual cost of health insurance this year will be displayed on Kynect, giving insurance-browsers both the basic premium cost and the subsidy before completing an application. Enrollees can also complete a preliminary eligibility determination to see if they qualify for Medicaid or a subsidy.

Check premium and subsidy estimates

Two types of subsidies are available. The premium tax credit can be taken in two ways: You can apply it to monthly payments, or take it when you file your tax return. The other type of subsidy, cost-sharing, is designed to minimize enrollees’ out-of-pocket costs when they go to the doctor or have a hospital stay.df

INCOME LIMITS FOR TAX-CREDIT SUBSIDIES

Lower-income families get the most help. You may qualify for payment assistance if your employer does not offer health insurance, you do not receive Medicare, or your family does not make more than the yearly income listed in the chart to the right. Click here for more information.

Let's consider the coverage eligibility of a man we will call John Smith to see how plans coverage differ from his options for 2014 plans. The individual market in Floyd County was limited to two companies in 2014, Anthem Blue Cross and the non-profit Kentucky Health Cooperative; Humana wasn't (and still isn't) offering individual coverage there. John could chose varying levels of plans, and based on the plan type, his premiums ranged from $182 (bronze) to $421 (platinum), with deductibles ranging from $6,300 (bronze) to $500 (platinum).

In 2015, John can still only chose between Anthemand the co-op. His premium options range from $204 (KHC-bronze) to $426 (Anthem-gold), with deductibles ranging from $5,750 (Anthem-bronze) to $1,000 (KHC and Anthem-platinum). However, be careful to watch out for high out-of-pocket costs, which for most bronze and silver plans, are $6,600 per person in 2015.

The estimated monthly premiums in the chart are the full price before any payment assistance. the total premium for the plan John wanted was estimated to be $415.48, but his income qualified him for a 47 percent subsidy. Using Kynect's Health Plan Savings Calculator, John's estimated actual cost is $220.80. The Kynect website will provide estimates of premiums and assistance, but the actual amount can't be determined until you complete a full application.

Important dates to remember

There are several key dates for you to keep in mind during this enrollment period, which is shorter than the first one:

Nov. 15: second open enrollment period began

Dec. 15: Consumers must select a plan for coverage to begin by Jan. 1. Currently enrolled consumers must renew coverage and application for financial system. If they fail to do so, current coverage and tax credits may be automatically renewed. (See below.)

Feb. 15: Last say of open enrollment period. Those consumers who select a plan on this date will begin new coverage March 1. Medicaid enrollment is open year-round.

April 15: Deadline for filing tax returns, on which taxpayers must indicate coverage in 2014 or face a penalty. Consumers who got tax-credit subsidies in 2014 must file a tax return.

Here is a new and crucial change: If you're already enrolled in a Kynect plan in 2014 and do nothing during open enrollment before December 15, 2014, you will be automatically re-enrolled in an existing plan for next year with your existing premium tax credit.

However, consumer advocates say doing nothing could be costly. If you have experienced changes in income or other circumstances that could affect your tax credit, you risk receiving the wrong amount and may have to pay back next year. Changes in the benchmark silver plans could lead to higher costs for some consumers. Even if the premium of a particular plan may go down, the decrease in the tax credit could be even more, resulting in a net increase, so consumers should pay particular attention to these changes.

Before the tax-filing deadline on April 15, consumers must use IRS Form 8962 to reconcile their estimated premium tax credit with the final premium tax credit eligibility. Consumers who overestimated their income may receive a tax refund, but those who underestimated it may have to repay some of all of the difference.

Those who miss the enrollment deadline may still qualify for special enrollment period if they experience what the law calls "life changing events," such as moving or losing your job.

Additional changes to Kynect include an enhanced website, more call center agents, expanded call-center hours, a Kynect storefront at Fayette Mall in Lexington, and a Kynect app for Apple and Android smartphones that allows users to access their Kynect account, see details of their plan and submit photos of documents for verification.

Expectant mothers need to get a flu shot as soon as it is available in their area, says the Centers for Disease Control and Prevention.

Only the flu shot, not the nasal-spray vaccine, is recommended for pregnant women because it is made with the inactivated (killed) virus. Pregnant women should not receive the spray vaccine, which is made with live attenuated (weakened) virus, BabyCenter, an online parenting and pregnancy resource, writes.

The changes to a pregnant woman's immune system, heart and lung function during pregnancy can make them even more sensitive to the flu, the CDC says.

Pregnant women have a harder time fighting off infections and are more likely to develop serious complications. They "are at a higher risk of hospitalization, and even death, than non-pregnant women," the CDC says. A severe illness in a pregnant mother can cause premature labor and delivery of the fetus and fever in early pregnancy can lead to birth defects.

Getting a flu shot during your pregnancy will also offer some protection to your baby up to six months after he or she is born, when the baby can be vaccinated. Breastfeeding your baby will also offer some protection from the flu. Studies show that babies who are breastfed do not get as sick and are sick less often than babies who are not breastfed.

If you did not get a flu shot during pregnancy, the CDC recommends that you get one after you deliver. After the baby is born you can get the either the flu shot or the nasal spray, even if you are breastfeeding. The CDC also recommends that anyone who comes in contact with your baby get a flu shot.

The CDC says pregnant women with flu-like symptoms should contact their health care proider immediately, but should seek emergency care if they are experiencing any of the following:

Doctors Without Borders will begin testing three experimental therapies to treat Ebola in December, bypassing the traditional progression of testing and giving the treatments directly to infected patients, Alice Park reports for Time magazine.

Driving this decision is the death toll, which has surpassed 5,000, with more than 14,000 patients still affected in West Africa, Park reports.

“We are on the front line, and when you have a disease that kills 50 percent to 70 percent of patients, then we have a certain responsibility to try to do our best to host trials for treatments in our facilities,” without waiting for the usual testing, Bertrand Draguez, medical director of Doctors Without Borders, told Park.

The treatment ZMapp, a combination of antibodies that was given to two U.S. aid workers who survived the infection, will not be one of the treatments because it is not available in enough doses to properly test in West Africa, Park reports. ZMapp is manufactured from a unique tobacco leaves grown in Owensboro, Ky.

The treatments that will be tested are the antiviral drug favipiravir, the antiviral drug brincidofovir, and whole blood and plasma from Ebola survivors.

Draguez told Park that the two antiviral drugs "rose to the top of the list because of a combination of their promise in controlling the Ebola virus and their availability," plus their ease of distribution; they are in pills, taken orally.

Patients will be given detailed information about the treatments and given the option of taking the experimental therapies, Park reports.

The World Health Organization recently announced plans to test two vaccines in West Africa as well.

These trials are a "good first step" in how best to treat Ebola, and while they might not help those currently infected, will be "invaluable for the inevitable outbreaks that emerge in the future," Park writes.

Kentucky's ranking for births to females aged 15 to 19 is going up, and five students at Casey County High School are pregnant. A joint baby shower for them during class time recently sent the wrong message about teenage pregnancy, a mother of a teenager at the school told the Casey County News.

Carmen Foster gained custody of her daughter three years ago, but not before the girl heard her biological mother say she enjoyed being pregnant because of all the attention she received. The biological mother left her and six other children with an abusive ex-boyfriend until Foster gained custody, Abigail Whitehouse reports.

"Some of these kids come from situations we can't even imagine," Foster said. "They need daily positive examples to help them reach their potential. I don't want my daughter thinking that being a pregnant teen will get her tons of positive attention from everyone at school."

Foster, who was a teenage mother, said she has spent years instructing her daughter that she doesn't need approval from boys to have self-confidence. "I want better for our girls," she said. "I believe in love and acceptance and helping in any way that I can, but I also believe in doing so responsibly. This was not a message to be sent out at school."

CCHS Principal Josh Blevins told the newspaper that the baby shower, in a Human and Child Development class, "was a way of saying, here are some things to help get them on their feet. We are just simply addressing the fact that this has happened, and now it's our responsibility to educate these women on how to care for their children." Blevins said the class is an elective, and participation isn't required.

Jackie Allen, who teaches the class, said the students were working through a unit on pregnancy and childbirth unit, and asked if they could throw a surprise baby shower for the five students. "I think it was a positive experience for my students and for the girls they invited," Allen said. "I think that students who are pregnant need all the support they can get. I don't think there was any kind of glorifying teen pregnancy."

Kentucky ranked seventh out of 51 (50 states and the District of Columbia) in 2011 birth rates among females 15-19, according to the U.S. Department of Health and Human Services. In 2008, the state Kentucky ranked 19th.

Friday, November 14, 2014

A new website called SugarScience is now available to help consumers understand the health dangers of sugar in our lives, Lisa Aliferis reports for NPR.

This University of California, San Francisco project examined 8,000 studies and research papers and "found strong evidence that over-consumption of added sugar contributes to three major chronic illnesses: heart disease, Type 2 diabetes and liver disease," Aliferis writes.

"Right now, the reality is that our consumption of sugar is out of whack, and until we bring things back into balance, we need to focus on helping people understand what the consequences are to having the average American ... consume too much added sugar," Laura Schmidt, a professor of health policy at UCSF and leader of this project, told Aliferis.

SugarScience is a user-friendly website that partners with health departments across the country to educate the public. Two departments have already agreed to participate in the outreach, Aliferis writes.

Schmidt told Aliferis that the food environment is the driver of the increased obesity of Americans in the last generation: "Sugar isn't just making us fat, it's making us sick."

"It's not like Americans suddenly lost their will power," she said. "The only major change in the diet that explains the obesity epidemic is this steep rise in added sugar consumption that started in the 1980s."

What our average daily diet of added sugar looks like

Schmidt said that while not all sugar is bad, we need to determine how much sugar is too much, pointing out that Americans consume the "equivalent of 19.5 teaspoons a day in added sugar, " Aliferis reports. She also suggest there is a need for federal guidelines to recommend a limit.

"SugarScience suggests the same limits advocated by the American Heart Association and the World Health Organization: no more than 9 teaspoons a day for men and no more than 6 teaspoons a day for women," Aliferis writes.

A taste of what the SugarScience website tells us is: Added sugar hides in 74 percent of packaged foods; fructose, a common type of sugar, can damage your liver more than other kinds of sugar; and one 12-ounce can of soda a day can increase your risk of dying of heart disease by one-third, Aliferis reports.

It also suggest the best way to cut down on sugar is to stop drinking sugar-sweetened drinks, saying this is where we get more than one-third of added sugar in our diets. Another suggestion is for us to read nutrition labels, suggesting that if a chemical on the label ends in "ose," it is probably sugar.

Dean Schillinger, a professor of medicine at UCSF and a primary care doctor at San Francisco General Hospital, is also part of the SugarScience team. He told Aliferis that beds in his hospital that used to be filled with AIDS patients are now filled with diabetes patients.

"The ward is overwhelmed with diabetes — they're getting their limbs amputated; they're on dialysis. And these are young people. They are suffering the ravages of diabetes in the prime of their life,"Schillinger told Aliferis.

"We're at the point where we need a public-health response to it, " he said.

The Centers for Medicare and Medicaid Services plan to start paying for lung cancer screening with low-dose CT scans for people at high risk.

Spiral CT (computed tomography), which is used to look for lung cancer, is a low-dose form of X-ray that delivers about the same radiation as a mammogram, Maggie Fox reports for NBC News.

“I think after a long effort to get to this point, CMS got it right,” Laurie Fenton Ambrose, president and CEO of the Lung Cancer Alliance, told Fox.
“This has the potential of being one of the most significant cancer mortality-reducing efforts to date. We are finally focusing on what is a quarter of all cancer, and that’s lung cancer.”

Fox reports, "Experts project that the screening test, which costs $250-$300, may prevent as many as 20 percent of future deaths from lung cancer, making it akin to mammograms and colonoscopies in terms of saving lives."

The proposal covers people aged 55-74 who have smoked at least a pack a day for 30 years, or the equivalent. It is now open for a 30-day comment period.

Lung cancer is especially deadly because it usually doesn’t cause symptoms until it’s already spread to other parts of the body. Kentucky has more cases of lung cancer than any other state, and its lung cancer mortality rate is nearly 50 percent higher than the national average. This year alone, 3,500 Kentuckians will die from lung cancer. Nationally, it kills nearly 160,000 people a year, according to the American Cancer Society.

Concerns about using CT scans to screen for ling cancer are that it isn't cheap, it isn't harmless, and the scans aren't always clear, often causing patients to endure further needless testing, Fox reports: "The national lung screening trial showed that for every five to six lives saved by screening, one person died because of procedures done after screening, including surgery and biopsies that collapsed the lung."

That calls for caution. “We strongly advise older current and former heavy smokers to speak with their doctors about whether CT lung cancer screening is right for them,” Dr. Ella Kazerooni, chair of the American College of Radiology Lung Cancer Screening Committee, told Fox. “If they and their doctor decide that screening is warranted, we encourage patients to seek out an ACR lung cancer screening center.”

Kentucky has not simply accepted the dire diabetes statistics that affect so many of its citizens, but instead is meeting this challenge head on with The Kentucky Diabetic Action Plan, Stewart Perry and Bob Babbage write in an op-ed piece for The Courier-Journal.

Perry and Babbage wrote this piece to draw attention to World Diabetes Day, held every year on Nov. 14 to engage people in advocacy and awareness about the disease.

"Thanks to the efforts of health care providers, political leaders and diabetes advocates and volunteers, Kentucky is a leader among the states in efforts to address the diabetes epidemic," the authors write.

"The incidence of diabetes has tripled in Kentucky since 1995. We have the fifth-highest incidence of diabetes among all the states. Almost 1 in 5 Kentuckians has diabetes or prediabetes. Diabetes costs Kentucky an estimated $4.8 billion a year in direct and indirect costs," the authors write.

They summarize the Action Plan, proudly saying that "no fewer than 15 states have used Kentucky's bill as a model for their own legislation."

"In 2011 Kentucky became the first state to mandate the development of a statewide, comprehensive diabetes action plan," they write. "The first Kentucky Diabetes Report was presented to the General Assembly in 2013 and will be updated every two years. Two years later, Kentucky became the first state to license diabetes educators. This year Kentucky passed Safe at School legislation which makes it easier for students to manage health care needs during school hours, provides that every school has trained personnel to assist students when necessary and assures that students with medical needs are not excluded from extracurricular activities."

The reason so many states are attempting to adopt this model, what makes it unique, say the authors, is that "the plan requires agencies to work together to develop a seamless, cooperative plan." The law requires the state Department of Public Health, the Department for Medicaid Services, the Office of Health Policy and the state Personnel Cabinet to collaborate in the development and implementation of the plan.

"We celebrate because Kentucky is not shrinking from the challenge of confronting diabetes but is instead at the forefront of efforts to prevent the disease and care for those who have diabetes," the authors write.

Better understanding brown fat could lead to future ways of treating obesity and type 2 diabetes, Abby Phillip reports for The Washington Post.

A recent study published in The Journal of Cell Biologyfound that brown fat cells are not only great "super calorie burners," burning calories as they help keep the body warm in cold temperatures, but are also a "super vacuum," producing a substance that sucks up excess glucose in the blood and transports that sugar into the brown fat cells, where it can be burned to produce heat, Phillip writes.

For people with type 2 diabetes, whose bodies do not use insulin properly and as a result have high blood glucose levels, these findings could lead to new drugs that can activate brown cells and reduce blood glucose levels without insulin, Phillip reports.

"If you can start the tissue to burn and produce heat, then you can actually in a way take away excess glucose in the blood," Tore Bengtsson, one of the study's authors told Phillip. "Now we actually understand how this production of these glucose transporters work."

Kentucky has the fifth-highest incidence of diabetes and obesity among all the states, with almost one in five Kentuckians diagnosed with diabetes or prediabetes and one in three adults in considered obese. Obesity can lead to the development of Type 2 diabetes.

"The implication of this is normally when you have Type 2 diabetes you have to inject insulin to reduce your blood sugar levels," Bengtsson told the Post. "However you could make a medicine which is not based on insulin signalling. It's a completely new pathway that can be targeted for taking up glucose in the blood."

Bengtsson told the newspaper "that he is working on the next step in the research -- looking for specific ways of activating the cells, which will be crucial for the development of new drugs."

Millions of low-income children across the country aren't getting free preventive exams and screenings guaranteed by Medicaid, and some experts say federal and state health officials aren't doing enough to fix the problem, according to a federal watchdog report.

The report from the Department of Health and Human Services’ Office of Inspector General says that while the Obama administration has boosted rates of participation for children getting regular wellness exams, dental checkups and vision and hearing tests, it needs to do more.

The report says that 63 percent of children on Medicaid received at least one medical screening in 2013, up from 56 percent in 2006, but most states are still falling short of the department’s 80 percent goal. Only Iowa and California met that participation rate goal last year.

In Kentucky, 57 percent of the 381,231 children covered by Medicaid who should have received at least one annual screening exam did so. Most states require at least one annual exam, and more frequent exams for infants. The reports shows that Kentucky's rate is better than 20 other states and equal to the rates in North Carolina, Rhode Island and Florida.

Some experts say state officials bear most of the responsibility for the low rates because they run Medicaid, the state-federal program for the poor, reports Phil Galewitz of Kaiser Health News. The OIG reports says the federal administration should be doing more to encourage states to address the problem.

"Child health advocates cite several factors for the low completion rates, including a shortage of doctors treating Medicaid patients, states’ low pay for providers and parents’ lack of awareness about the importance of the visits," writes Galewitz.

Congress introduced the Medicaid benefit, known as the Early and Periodic Screening, Diagnosis and Treatment program in 1967. In Kentucky, the EPSDT benefit includes screenings and special services, according to the Cabinet for Health and Human Services. Preventive care, such as routine physicals or well-child check ups, is provided under the screenings program.

Last year, 514,298 children were eligible for Kentucky’s EPSDT, says the the cabinet's annual participation report. Based on that number and eligibility periods, about 507,000 screenings were expected, but only 391,079 were, for a ratio of 83%. Additionally, the report says 236,830 children received dental services of any kind, with 208,783 receiving preventive services.

Some states require Medicaid health plans to educate members about the EPSDT benefit and what it covers. Others have implemented incentive plans that offer gift certificates for screenings. According to the National Academy for State Health Policy, Kentucky requires Medicaid managed-care organizations to provide an EPSDT coordinator to coordinate case-management services and continuity of care. Click here for more information about EPSDT screenings in Kentucky.

Laundry detergent pods, a convenience product that can be tossed into washing machines without having to measure out a liquid or powder, caused more than 700 children to be hospitalized in 2012-2013, with one confirmed death, according to a new study from Nationwide Children’s Hospital.

Photo: University of Virginia Health System

The study, published online in the journal Pediatrics, evaluated U.S. poison-control data from 2012 to 2013 and found 17,230 reports of children younger than six who had been injured from the laundry pods. That is nearly one child every hour, says the news release.

Two-thirds of the cases were one- and two year-olds, with most of the exposures reported due to ingestion.

Because the pods are usually brightly colored, young children, who naturally explore their environments orally, put them in their mouths. The water-soluble covering on the pods is easily penetrated, allowing the concentrated detergent to be ingested.

"Laundry detergent pods are small, colorful, and may look like candy or juice to a young child,” Marcel J. Casavant, co-author of the study, said in the release. “It can take just a few seconds for children to grab them, break them open, and swallow the toxic chemicals they contain, or get the chemicals in their eyes.”

While some manufacturers of laundry detergent pods have changed packaging to make pods less attractive to children, many have not.

“It is not clear that any laundry detergent pods currently available are truly child resistant; a national safety standard is needed to make sure that all pod makers adopt safer packaging and labeling,” said Gary Smith, the study’s senior author. “Parents of young children should use traditional detergent instead of detergent pods.”

Parents and child caregivers can help children stay safe by following these tips:

Use traditional laundry detergent, it is less toxic than the pods.

Store laundry detergent pods up, away and out of sight - preferably in a locked cabinet.

Close laundry detergent pod packages or containers and put away immediately after use.

Put the national Poison Help Line number (1-800-222-1222) in your cell phone and post it near your home phones.

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Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.Republication of any KHN material with proper credit is hereby authorized, but if the republication is longer than a news brief we ask that it contain the first sentence of this paragraph. Thanks!